{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:28:53Z","timestamp":1766514533506,"version":"3.48.0"},"reference-count":58,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004937","name":"Bundesministerium f\u00fcr Forschung und Technologie","doi-asserted-by":"publisher","award":["01KG2405"],"award-info":[{"award-number":["01KG2405"]}],"id":[{"id":"10.13039\/501100004937","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Odontoid fractures of the second cervical vertebra commonly affect elderly patients due to osteoporosis and low-energy trauma. Treatment is controversial, with prolonged cervical collar immobilization risking non-union and complications, and surgical C1\u2013C2 stabilization involving higher upfront surgical risks. High-level evidence from randomized controlled trials to guide optimal treatment decisions is lacking. The SCORE study aims to determine whether surgical stabilization is non-inferior to conservative collar management in maintaining functional independence for elderly patients with unstable odontoid fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>SCORE is a multicenter, parallel-group, randomized controlled non-inferiority trial enrolling 322 patients aged \u226570 years with acute (\u22642 weeks) unstable odontoid Type II, III, or atypical fractures. Participants will be randomized 1:1, stratified by center, to receive surgical stabilization via posterior C1\u2013C2 fixation or conservative management with a rigid cervical collar. The primary outcome measure is the change in Barthel Index (BI) from baseline to 12 weeks. Secondary outcomes include quality of life (EQ-5D), neck pain (Visual Analog Scale, VAS), neck disability (Neck Disability Index, NDI), radiographic fusion, treatment compliance, cross-over rates to surgery, and incidence of adverse and serious adverse events up to 6 months. Follow-ups will take place at 12 weeks and 6 months post-injury, with an additional visit at approximately 2 weeks post-surgery for surgical patients. Analysis will use mixed models for repeated measures, targeting 90% power to detect non-inferiority within a 5-point margin on the BI (one-sided \u03b1\u2009=\u20090.025), accounting for 15% attrition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This trial addresses a critical evidence gap by directly comparing surgical and conservative treatments, aiming to guide clinical decision-making and improve functional outcomes and quality of life in elderly patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov, ID: NCT06961578<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0337999","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:24:11Z","timestamp":1766514251000},"page":"e0337999","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical versus conservative treatment of odontoid fractures in the elderly: A randomized controlled clinical study (SCORE)"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9947-2240","authenticated-orcid":true,"given":"Arthur","family":"Wagner","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolin","family":"Albrecht","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Dittmer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Egert-Schwender","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Kehl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Stichling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gisela","family":"Klatt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Ettinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9989-649X","authenticated-orcid":true,"given":"Nils","family":"Hecht","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Vajkoczy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Wengert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Kandziora","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas Heinz","family":"von der H\u00f6h","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph-Eckhard","family":"Heyde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Hartung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus","family":"Richter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Lenz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peer","family":"Eysel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Badke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Blume","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8258-9346","authenticated-orcid":true,"given":"Hans","family":"Clusmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Walter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandro","family":"Krieg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3595-0367","authenticated-orcid":true,"given":"Petros","family":"Evangelou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ehab","family":"Shiban","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1055-8695","authenticated-orcid":true,"given":"Marc","family":"Dreimann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Gembruch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9073-1821","authenticated-orcid":true,"given":"Ulrich","family":"Sure","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Bettag","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veit","family":"Rohde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Disch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biniam","family":"Bekele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Mi","family":"Ryang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0168-0178","authenticated-orcid":true,"given":"Andreas","family":"Kramer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Ringel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Wach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erdem","family":"G\u00fcresir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6486-7955","authenticated-orcid":true,"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Wostrack","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"issue":"7","key":"pone.0337999.ref001","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1002\/jbmr.3120","article-title":"Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly","volume":"32","author":"J Kaesmacher","year":"2017","journal-title":"J Bone Miner Res"},{"key":"pone.0337999.ref002","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.wneu.2015.12.026","article-title":"Early Morbidity and Mortality in 50 Very Elderly Patients After Posterior Atlantoaxial Fusion for Traumatic Odontoid Fractures","volume":"87","author":"Y-M Ryang","year":"2016","journal-title":"World Neurosurg"},{"key":"pone.0337999.ref003","article-title":"Management of upper cervical spine fractures in elderly patients: current trends and outcomes","author":"T Delcourt","year":"2015","journal-title":"Injury"},{"issue":"4","key":"pone.0337999.ref004","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1177\/2151458515593774","article-title":"Longer-Term Outcomes of Geriatric Odontoid Fracture Nonunion","volume":"6","author":"B Raudenbush","year":"2015","journal-title":"Geriatr Orthop Surg Rehabil"},{"issue":"4","key":"pone.0337999.ref005","first-page":"543","article-title":"Odontoid fractures in the octogenarian: a systematic review and meta-analysis","volume":"60","author":"H Deng","year":"2016","journal-title":"J Neurosurg Sci"},{"key":"pone.0337999.ref006","article-title":"Controversies in the Management of Geriatric Odontoid Fractures","author":"SC Wagner","year":"2017","journal-title":"J Orthop Trauma"},{"issue":"2","key":"pone.0337999.ref007","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/BRS.0000000000003734","article-title":"A Nationwide Analysis of Geriatric Odontoid Fracture Incidence, Complications, Mortality, and Cost","volume":"46","author":"R Alluri","year":"2021","journal-title":"Spine (Phila Pa 1976)"},{"issue":"15","key":"pone.0337999.ref008","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1097\/BRS.0000000000004010","article-title":"Risk Factors Associated with 90-day Readmissions Following Odontoid Fractures: A Nationwide Readmissions Database Study","volume":"46","author":"A von Glinski","year":"2021","journal-title":"Spine (Phila Pa 1976)"},{"key":"pone.0337999.ref009","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jocn.2021.08.027","article-title":"Too frail is to fail: Frailty portends poor outcomes in the elderly with type II odontoid fractures independent of management strategy","volume":"93","author":"LP Carlstrom","year":"2021","journal-title":"J Clin Neurosci"},{"issue":"8","key":"pone.0337999.ref010","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1177\/21925682221087194","article-title":"Adverse Events Relating to Prolonged Hard Collar Immobilisation: A Systematic Review and Meta-Analysis","volume":"12","author":"JFM Brannigan","year":"2022","journal-title":"Global Spine J"},{"issue":"26","key":"pone.0337999.ref011","first-page":"2240","article-title":"Effect of type II odontoid fracture nonunion on outcome among elderly patients treated without surgery: based on the AOSpine North America geriatric odontoid fracture study","volume":"38","author":"JS Smith","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"key":"pone.0337999.ref012","first-page":"6516893","article-title":"Epidemiology of C2 Fractures in the 21st Century: A National Registry Cohort Study of 6,370 Patients from 1997 to 2014","volume":"2017","author":"A-L Robinson","year":"2017","journal-title":"Adv Orthop"},{"issue":"2","key":"pone.0337999.ref013","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s00586-010-1507-6","article-title":"Type II odontoid fractures in the elderly: an evidence-based narrative review of management","volume":"20","author":"D Pal","year":"2011","journal-title":"Eur Spine J"},{"issue":"13","key":"pone.0337999.ref014","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1097\/BRS.0b013e318286f0cf","article-title":"The AOSpine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up","volume":"38","author":"J Chapman","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"key":"pone.0337999.ref015","doi-asserted-by":"crossref","DOI":"10.1177\/21925682231157316","article-title":"Geriatric Odontoid Fractures: Treatment Algorithms of the German Society for Orthopaedics and Trauma Based on Expert Consensus and a Systematic Review","volume":"13","author":"G Osterhoff","year":"2023","journal-title":"Global Spine J"},{"issue":"3","key":"pone.0337999.ref016","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/BRS.0000000000004510","article-title":"A Predictive Model to Identify Treatment-related Risk Factors for Odontoid Fracture Nonunion Using Machine Learning","volume":"48","author":"I Leister","year":"2023","journal-title":"Spine (Phila Pa 1976)"},{"key":"pone.0337999.ref017","first-page":"33","article-title":"Conservative management of Anderson Type II odontoid fractures in octogenarians: is radiological union what we are searching for?","volume":"26","author":"D Candura","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"21","key":"pone.0337999.ref018","doi-asserted-by":"crossref","DOI":"10.3390\/cancers14215275","article-title":"CFR-PEEK pedicle screw instrumentation for spinal neoplasms: a single center experience on safety and efficacy","volume":"14","author":"AK Joerger","year":"2022","journal-title":"Cancers"},{"issue":"13","key":"pone.0337999.ref019","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1097\/BRS.0000000000002982","article-title":"Functional Outcome of Elderly Patients Treated for Odontoid Fracture: A Multicenter Study","volume":"44","author":"P De Bonis","year":"2019","journal-title":"Spine (Phila Pa 1976)"},{"key":"pone.0337999.ref020","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/BF01400872","article-title":"Plate and screw fixation for atlanto-axial subluxation","volume":"129","author":"A Goel","year":"1994","journal-title":"Acta Neurochir (Wien)"},{"issue":"1","key":"pone.0337999.ref021","doi-asserted-by":"crossref","first-page":"6276","DOI":"10.1038\/s41598-023-33158-3","article-title":"Multicenter retrospective cohort study of the association between surgery for odontoid fractures in the elderly and in-hospital outcomes","volume":"13","author":"Z Merali","year":"2023","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0337999.ref022","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1186\/s12893-020-00893-7","article-title":"Odontoid fractures: impact of age and comorbidities on surgical decision making","volume":"20","author":"SAM Rizvi","year":"2020","journal-title":"BMC Surg"},{"issue":"6","key":"pone.0337999.ref023","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1055\/a-0989-2791","article-title":"Recommendations for Diagnosis and Treatment of Odontoid Fractures in Geriatric Patients","volume":"158","author":"G Osterhoff","year":"2020","journal-title":"Z Orthop Unfall"},{"key":"pone.0337999.ref024","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/1471-2474-15-7","article-title":"Rationale and design of the INNOVATE Trial: an international cooperative study on surgical versus conservative treatment for odontoid fractures in the elderly","volume":"15","author":"JGJ Huybregts","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"issue":"8","key":"pone.0337999.ref025","article-title":"Surgical versus conservative treatment for odontoid fractures in older people: an international prospective comparative study","volume":"53","author":"JGJ Huybregts","year":"2024","journal-title":"Age Ageing"},{"issue":"1","key":"pone.0337999.ref026","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1186\/s13063-018-2690-8","article-title":"Surgical vs. non-surgical management of displaced type-2 odontoid fractures in patients aged 75 years and older: study protocol for a randomised controlled trial","volume":"19","author":"A-L Robinson","year":"2018","journal-title":"Trials"},{"issue":"4","key":"pone.0337999.ref027","doi-asserted-by":"crossref","DOI":"10.1227\/NEU.0000000000000886","article-title":"Quality of Life and General Health After Elective Surgery for Cervical Spine Pathologies: Determining a Valid and Responsive Metric of Health State Utility","volume":"77","author":"S Chotai","year":"2015","journal-title":"Neurosurgery"},{"issue":"8","key":"pone.0337999.ref028","doi-asserted-by":"crossref","first-page":"729","DOI":"10.2106\/JBJS.K.01636","article-title":"Functional and quality-of-life outcomes in geriatric patients with type-II dens fracture","volume":"95","author":"AR Vaccaro","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"7","key":"pone.0337999.ref029","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.jmpt.2008.08.006","article-title":"The neck disability index: state-of-the-art, 1991-2008","volume":"31","author":"H Vernon","year":"2008","journal-title":"J Manipulative Physiol Ther"},{"issue":"2","key":"pone.0337999.ref030","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3109\/09638288809164105","article-title":"The Barthel ADL Index: a standard measure of physical disability?","volume":"10","author":"DT Wade","year":"1988","journal-title":"Int Disabil Stud"},{"issue":"8","key":"pone.0337999.ref031","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1111\/ggi.13723","article-title":"Development of the Barthel Index 5\u2009years after hip fracture: Results of a prospective study","volume":"19","author":"T Knauf","year":"2019","journal-title":"Geriatr Gerontol Int"},{"issue":"4","key":"pone.0337999.ref032","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamda.2018.09.033","article-title":"Measurement Properties of the Barthel Index in Geriatric Rehabilitation","volume":"20","author":"H Bouwstra","year":"2019","journal-title":"J Am Med Dir Assoc"},{"issue":"1","key":"pone.0337999.ref033","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1186\/s12877-019-1223-y","article-title":"Geriatric scores can predict long-term survival rate after hip fracture surgery","volume":"19","author":"C da Casa","year":"2019","journal-title":"BMC Geriatr"},{"key":"pone.0337999.ref034","doi-asserted-by":"crossref","first-page":"282","DOI":"10.3389\/fpsyt.2020.00282","article-title":"Is Barthel Index Suitable for Assessing Activities of Daily Living in Patients With Dementia?","volume":"11","author":"Y Yi","year":"2020","journal-title":"Front Psychiatry"},{"issue":"4","key":"pone.0337999.ref035","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamda.2019.09.015","article-title":"Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis","volume":"21","author":"C Loyd","year":"2020","journal-title":"J Am Med Dir Assoc"},{"issue":"4","key":"pone.0337999.ref036","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.1111\/jan.14708","article-title":"The Barthel index as an indicator of hospital outcomes: A retrospective cross-sectional study with healthcare data from older people","volume":"77","author":"H Ocagli","year":"2021","journal-title":"J Adv Nurs"},{"issue":"5","key":"pone.0337999.ref037","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1007\/s00586-023-07618-3","article-title":"Age-based exclusion is common and multifactorial in spinal RCTs: a systematic review and quantitative analysis","volume":"32","author":"G Chew","year":"2023","journal-title":"Eur Spine J"},{"issue":"1","key":"pone.0337999.ref038","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/0020-1383(92)90123-A","article-title":"The epidemiology of fractures and fracture-dislocations of the cervical spine","volume":"23","author":"MD Ryan","year":"1992","journal-title":"Injury"},{"issue":"26","key":"pone.0337999.ref039","doi-asserted-by":"crossref","first-page":"2881","DOI":"10.1097\/BRS.0b013e31818d5407","article-title":"Nonoperative management of type II odontoid fractures in the elderly","volume":"33","author":"F Koech","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"pone.0337999.ref040","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1007\/s005860050188","article-title":"Management of odontoid fractures in the elderly","volume":"8","author":"EJ M\u00fcller","year":"1999","journal-title":"Eur Spine J"},{"key":"pone.0337999.ref041","first-page":"8321680","article-title":"C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age: A Retrospective Cohort Study of 233 Consecutive Cases","volume":"2017","author":"A-L Robinson","year":"2017","journal-title":"Biomed Res Int"},{"issue":"5","key":"pone.0337999.ref042","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1007\/s00586-019-06244-2","article-title":"C1-C2 posterior screw fixation in atlantoaxial fractures revisited: technical update based on 127 cases","volume":"29","author":"N Buchmann","year":"2020","journal-title":"Eur Spine J"},{"issue":"3","key":"pone.0337999.ref043","doi-asserted-by":"crossref","first-page":"442","DOI":"10.14444\/8250","article-title":"Treatment of Odontoid Fractures in Elderly Patients Using C1\/C2 Instrumented Fusion Supplemented With Bilateral Atlantoaxial Joint Spacers: A Case Series","volume":"16","author":"F Sommer","year":"2022","journal-title":"Int J Spine Surg"},{"issue":"4","key":"pone.0337999.ref044","doi-asserted-by":"crossref","first-page":"623","DOI":"10.3171\/2020.8.SPINE20860","article-title":"Institutional review of the management of type II odontoid fractures: associations and outcomes with fibrous union","volume":"34","author":"C Wilson","year":"2021","journal-title":"J Neurosurg Spine"},{"issue":"2","key":"pone.0337999.ref045","doi-asserted-by":"crossref","first-page":"196","DOI":"10.3171\/2023.3.SPINE221001","article-title":"Outcomes following anterior odontoid screw versus posterior arthrodesis for odontoid fractures: a systematic review and meta-analysis","volume":"39","author":"P Texakalidis","year":"2023","journal-title":"J Neurosurg Spine"},{"issue":"5","key":"pone.0337999.ref046","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1097\/BSD.0b013e3181b11d9f","article-title":"Management of type II odontoid fractures in the geriatric population: outcome of treatment in a rigid cervical orthosis","volume":"23","author":"A Chaudhary","year":"2010","journal-title":"J Spinal Disord Tech"},{"key":"pone.0337999.ref047","article-title":"SPIRIT 2025 statement: updated guideline for protocols of randomised trials","volume":"389","author":"A-W Chan","year":"2025","journal-title":"BMJ"},{"issue":"12","key":"pone.0337999.ref048","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1007\/s00402-018-3020-z","article-title":"Validity and responsiveness of Barthel index for measuring functional recovery after hemiarthroplasty for femoral neck fracture","volume":"138","author":"A Unnanuntana","year":"2018","journal-title":"Arch Orthop Trauma Surg"},{"issue":"5","key":"pone.0337999.ref049","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.spinee.2007.01.008","article-title":"Understanding the minimum clinically important difference: a review of concepts and methods","volume":"7","author":"AG Copay","year":"2007","journal-title":"Spine J"},{"key":"pone.0337999.ref050","article-title":"Treatment of Odontoid Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)","volume":"8","author":"O Gonschorek","year":"2018","journal-title":"Glob Spine J"},{"issue":"4","key":"pone.0337999.ref051","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1177\/2151458515593774","article-title":"Longer-Term Outcomes of Geriatric Odontoid Fracture Nonunion","volume":"6","author":"B Raudenbush","year":"2015","journal-title":"Geriatr Orthop Surg Rehabil"},{"issue":"1","key":"pone.0337999.ref052","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/s12871-021-01337-2","article-title":"Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis","volume":"21","author":"A Saripella","year":"2021","journal-title":"BMC Anesthesiol"},{"key":"pone.0337999.ref053","article-title":"Using frailty measures to predict functional outcomes and mortality after type II odontoid fracture in elderly patients: A retrospective cohort study","author":"FA Hamrick","year":"2023","journal-title":"Glob Spine J"},{"key":"pone.0337999.ref054","doi-asserted-by":"crossref","first-page":"101756","DOI":"10.1016\/j.bas.2023.101756","article-title":"The role of extended coagulation screening in adult cranial neurosurgery","volume":"3","author":"A Wagner","year":"2023","journal-title":"Brain Spine"},{"issue":"1","key":"pone.0337999.ref055","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.archger.2013.03.007","article-title":"Not just specific diseases: systematic review of the association of geriatric syndromes with hospitalization or nursing home admission","volume":"57","author":"S-Y Wang","year":"2013","journal-title":"Arch Gerontol Geriatr"},{"issue":"9","key":"pone.0337999.ref056","doi-asserted-by":"crossref","DOI":"10.3390\/cancers14092249","article-title":"Surgery in Acute Metastatic Spinal Cord Compression: Timing and Functional Outcome","volume":"14","author":"HS Meyer","year":"2022","journal-title":"Cancers"},{"issue":"1","key":"pone.0337999.ref057","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s12955-021-01719-7","article-title":"EQ-5D-5L reference values for the German general elderly population","volume":"19","author":"O Marten","year":"2021","journal-title":"Health Qual Life Outcomes"},{"key":"pone.0337999.ref058","author":"EuroQol","year":"2009"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0337999","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:24:18Z","timestamp":1766514258000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0337999"}},"subtitle":[],"editor":[{"given":"Jen","family":"Edwards","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,23]]},"references-count":58,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0337999","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,23]]}}}